By Kaley Abato, MSPT (on the right).   Kaley is PT for Bacharach Rehabilitation in Margate, NJ.  She obtained her Masters degree at Stockton and was also a student athletic trainer here for 4 years..

It hurts where? 
Typically the athlete complains of aching pain on the lateral aspect of the knee.  They will often describe a dull aching pain a mile or two into a run that lingers during the run but may disappear soon after stopping.  Pain is usually felt near the lateral femoral condyle sometimes extending proximally and distally.  The athlete will also complain of point tenderness over the lateral femoral condyle. 

How does it happen? 
ITB syndrome has a gradual onset from overuse of the knee.  This overuse causes shortening of the ITB.   It occurs most frequently in runners with pes cavus (high arches) and genu varus (bow legs).  ITB can also occur from leg length discrepancies or muscle imbalances around the knee.  Many cases will have a history of Patellofemoral problems.  It often occurs from an increase in running distance, intensity, duration, and/or frequency (poor training techniques).  The result of these problems is the repeated flexion and extension of the knee now causes friction of the ITB at the femoral condyle producing inflammation and pain.  

Similar Injuries 
ITB can mimic a LCL sprain or lateral meniscal injury.  Both of these injuries usually occur suddenly from a direct force or rotation of the knee.  The athlete needs to be assessed for foot deformities.  These can cause abnormal stress to the knee contributing to overuse of the ITB.  ITB may also be associated with the following problems: hip abductor contracture, genu varum, heel and foot pronation, tightness of the achilles, or internal rotation of the tibia. 

Treatment 
Treatment is focused on symptom relief with the use of NSAIDs, ice, and other modalities to control pain and inflammation.  Strengthening is focused on the hip and knee muscles to balance the forces on the knee.  Stretching of the ITB is used to decrease the stress on the knee.  Transverse friction massage and soft tissue mobilization may also be helpful.  Athletes may initially need to take some time off and should be instructed to avoid activities that reproduce their pain.  An athlete who is not responding to rehab should be assessed for foot deformities causing stress on the knee. 

Participation Status 
Participation is dependent on the severity of the injury.  An athlete with a recent onset can participate as tolerated accompanied by ice after practice and a regular rehab program.  An athlete that has been experiencing pain for a longer period of time may need to take some time off with rehab and gradually return to activity.   The athlete that presents with foot deformities should be referred for orthotics.